Healthcare Provider Details

I. General information

NPI: 1265464648
Provider Name (Legal Business Name): TOMAS D MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMAS DITTO MARTIN M.D.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1211
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0129
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9730
  • Fax: 352-273-9737
Mailing address:
  • Phone: 352-273-9730
  • Fax: 352-273-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME54789
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME54789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: